Caregiver strain and attention-deficit/hyperactivity disorder: Predictors in adolescence and young adulthood

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Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic disorder often extending into adolescence and adulthood. It is associated with impairment in multiple domains of functioning, including family functioning. Children with ADHD contribute undue stress in their relationships with caregivers, and caregivers report increased levels of caregiver strain (CS). Limited work is available on CS in ADHD samples, and most studies are limited to elementary-aged children. The present study investigated lifetime-reported CS in mothers of those with and without ADHD. This study utilized a follow-up study of participants diagnosed and treated for ADHD in childhood. Participants and their parents were re-contacted and enrolled in adolescence and young adulthood, as was a matched comparison group. Data were aggregated over three annual “waves” of follow-up, with lifetime maternal CS assessed at the third wave of data collection. Group differences were found between the mothers with and without an ADHD child, with mothers of an ADHD child reporting significantly higher lifetime CS. Predictors of lifetime maternal CS were explored within the ADHD sample. A hierarchical model examining indices of symptom severity, family stress, child impairment, and lifetime treatment use accounted for a substantial portion of the variance of lifetime maternal CS ( R 2 = .46). Specifically, baseline and current oppositional symptom severity, delinquency, school discipline, and lifetime treatment use uniquely predicted lifetime maternal caregiver strain. Additionally, individual mediation models were created and several variables (current ADHD symptom severity, current ODD symptom severity, delinquency, and school disciplinary action) partially mediated the relationship between baseline ADHD symptom severity and lifetime maternal CS. A path analysis was modeled fit the data well. Baseline ADHD was mediated by current ODD, delinquency and school discipline. This study is the first to document group differences in lifetime maternal CS in a sample of ADHD and comparison individuals, and found that oppositional symptom severity and problems in key domains of daily life functioning within the ADHD sample predicted CS. This documents the importance of child/adolescent impairments in daily life as key factors in producing CS. Thus, the current study expands the understanding of CS in families with an ADHD child through the lifespan.